Clinical characteristics and mortality of critically ill patients with chikungunya infection: a multicenter study in Paraguay

Chikungunya virus (CHIKV) infection can progress to severe clinical forms requiring intensive care. This study aimed to characterize adult patients admitted to intensive care units (ICUs) with CHIKV during the 2023 epidemic in five hospitals in the Central Department of Paraguay. It also sought to estimate mortality and explore clinical and biochemical factors linked to poor outcomes to facilitate early identification of high-risk patients and guide targeted therapies. A multicenter retrospective observational cohort study with an analytical component was conducted through a retrospective review of medical records. Adult patients admitted to the ICU of four hospitals between January and June 2023 were included if they had confirmed CHIKV infection (RT-PCR or serology) requiring intensive care. The data collected included demographics, comorbidities, clinical presentation, laboratory findings, interventions (mechanical ventilation, vasopressors, renal replacement therapy), ICU stay, and mortality. APACHE II and SOFA scores were calculated at the time of UCI admission. Thirty-four patients were included, with a median age of 66 years (range 22–89), predominantly male (55.9%). Hypertension (64.7%) and obesity (35.3%) were the most frequent comorbidities. The most common presenting symptoms were fever (82.4%), gastrointestinal manifestations (76.5%), asthenia or anorexia (70.6%), and neurological symptoms (58.8%). The median APACHE II and SOFA scores on ICU admission were 19 and 7, respectively. Mechanical ventilation and vasopressors support were required in 79.4% of patients, while renal replacement therapy was needed in 32.4%. Overall mortality was 55.9%. Atypical presentations occurred in 88.2% of cases, predominantly with renal (36.7%) and neurological (33.3%) involvement. Higher APACHE II and SOFA scores, as well as the need for mechanical ventilation, vasopressors, and renal therapy were significantly associated with mortality. This first description of severe CHIKV infection in Paraguay highlights extensive multiorgan involvement, a high requirement for advanced life support use, and elevated mortality associated with the disease.